Lower back pain is one of the most common reasons adults seek physiotherapy. Many people assume that if they feel pain in their lower back, the problem must be coming from their spine. However, this is not always the case.
In some situations, the hips—not the lower back—may be contributing to your discomfort. Because the lower back and hips work closely together during almost every movement, a problem in one area can place extra stress on the other. This can make it difficult to identify the true source of the pain without a proper assessment.
At CN Physiotherapy, we regularly assess patients whose lower back pain is actually influenced by hip stiffness, muscle weakness, poor movement patterns, or hip joint dysfunction. Understanding where your symptoms are coming from is the first step toward effective treatment.
We proudly help patients throughout Ottawa, Orléans, Fallingbrook, Navan, Blackburn Hamlet, Beacon Hill, Cumberland, Nepean, and surrounding communities.
Why Your Back and Hips Work Together
Your hips and lower back form part of one movement system.
Every time you:
- Walk
- Sit down
- Stand up
- Climb stairs
- Bend forward
- Lift an object
- Run
- Play sports
- Get into your vehicle
…your hips and spine share the workload.
Healthy hip joints should move freely in multiple directions while the muscles surrounding them provide stability and strength. If the hips lose mobility or strength, the lower back often compensates by moving more than it should.
Over time, this additional strain may contribute to recurring back pain.
How Hip Problems Can Cause Back Pain
The body naturally tries to keep you moving.
If one joint becomes stiff or painful, nearby joints often compensate.
For example:
- A stiff hip may force the lower back to rotate more.
- Weak hip muscles may reduce pelvic stability during walking.
- Limited hip extension may increase stress on the lumbar spine while walking or climbing stairs.
- Poor hip control may change lifting mechanics.
These compensations may continue for weeks or months before pain finally develops in the lower back.
The painful area is not always the original source of the problem.
Signs Your Hips May Be Contributing to Your Back Pain
Although every patient is different, several clues may suggest the hips deserve closer attention.
Your Pain Is Worse After Sitting
Long periods of sitting may cause the hip flexor muscles to tighten while reducing hip mobility.
When you stand up, the lower back may compensate for the restricted hip movement.
Many people notice:
- Tightness after driving
- Difficulty standing upright
- Back pain after office work
- Discomfort after watching television
You Feel Pain in the Buttock
Pain located deep in the buttock is sometimes related to the hip joint or surrounding muscles.
Although buttock pain can also come from the lower back, the hips should always be evaluated during assessment.
One Hip Feels Stiff
Difficulty putting on shoes or socks, crossing your legs, or rotating your hip may indicate reduced hip mobility.
If one hip moves less than the other, the lower back often compensates.
Walking Increases Your Back Pain
Walking should involve smooth movement through both hips.
If the hips cannot extend properly, the lower back may arch more than necessary during every step.
This repeated compensation may gradually increase irritation.
Standing on One Leg Feels Difficult
Hip muscles play a major role in stabilizing the pelvis.
Weakness in these muscles may increase stress on both the hip and lower back during walking, stair climbing, and daily activities.
Common Hip Conditions That May Cause Back Pain
Several hip conditions may contribute to lower back symptoms.
These include:
Hip Osteoarthritis
Hip osteoarthritis gradually changes the joint over time.
Symptoms may include:
- Groin pain
- Buttock pain
- Morning stiffness
- Reduced hip mobility
- Difficulty walking
- Back pain caused by compensation
Hip arthritis often develops gradually and may initially feel like a muscle strain.
Hip Muscle Weakness
The gluteal muscles help stabilize the pelvis during movement.
When these muscles become weak, the lower back often performs more work than it should.
Weak hip muscles are common among people who:
- Sit for long periods
- Recently reduced activity
- Recover from injury
- Return to exercise too quickly
Hip Flexor Tightness
The hip flexors connect the upper thigh to the pelvis and lower spine.
Long hours of sitting may shorten these muscles temporarily.
Limited hip extension can increase stress on the lower back during walking and standing.
Gluteal Tendinopathy
Pain along the outside of the hip may alter walking mechanics and increase lower back strain.
This condition often becomes uncomfortable when:
- Walking
- Climbing stairs
- Sleeping on one side
- Standing for long periods
Femoroacetabular Impingement (FAI)
Some people experience pain because the bones of the hip joint come into contact during movement.
Reduced hip motion caused by FAI may increase compensatory movement through the lumbar spine.
Sometimes the Problem Really Is the Back
Not all lower back pain comes from the hips.
Your physiotherapist must determine whether symptoms originate from:
- Muscles
- Ligaments
- Discs
- Facet joints
- Nerves
- Hip joints
- Sacroiliac joints
- Or a combination of several structures
This is why guessing based only on where pain is felt can be misleading.
How Physiotherapists Differentiate Hip Pain From Back Pain
During your assessment, your physiotherapist examines much more than the painful area.
Your evaluation may include:
- Hip range of motion
- Lumbar spine movement
- Muscle strength
- Walking mechanics
- Balance
- Functional movements
- Sitting posture
- Lifting technique
- Joint mobility
- Flexibility
- Neurological testing if required
Certain movements may reproduce hip symptoms while others affect the spine.
This information helps determine which structures are contributing most to your pain.
Why Imaging Doesn’t Always Tell the Full Story
Many people believe an X-ray or MRI is necessary before treatment begins.
While imaging can be helpful in certain situations, it does not always explain the cause of pain.
Many adults have age-related changes visible on imaging despite having little or no symptoms.
Conversely, some patients experience significant pain even though imaging shows only minor changes.
A detailed physical assessment remains one of the most valuable tools for identifying movement problems.
How Physiotherapy Can Help
Once the true source of your symptoms has been identified, treatment can be tailored to your needs.
Depending on the findings, your physiotherapy program may include:
Therapeutic Exercise
Exercise helps restore:
- Hip strength
- Core stability
- Lower-back endurance
- Balance
- Functional movement
- Walking mechanics
Every exercise program should be individualized rather than copied from generic online routines.
Manual Therapy
Hands-on treatment may help improve mobility in stiff joints and surrounding soft tissues.
Manual therapy is often combined with active rehabilitation for longer-lasting improvement.
Hip Mobility Exercises
Improving hip mobility may reduce unnecessary stress placed on the lumbar spine during daily activities.
Core Strengthening
Strong abdominal and trunk muscles help distribute forces more efficiently during lifting, walking, and exercise.
Movement Retraining
Many patients unknowingly develop movement habits that overload the lower back.
Your physiotherapist may help improve:
- Squatting
- Bending
- Lifting
- Stair climbing
- Walking
- Exercise technique
Can Stretching Alone Fix the Problem?
Not usually.
Many people search online for “best stretches for back pain.”
Stretching may temporarily reduce stiffness, but it does not always address:
- Weak muscles
- Poor movement patterns
- Joint stiffness
- Reduced balance
- Activity overload
If hip weakness is contributing to your back pain, stretching alone is unlikely to provide lasting improvement.
Everyday Habits That May Reduce Back and Hip Strain
Small changes throughout the day may help reduce repeated stress.
Helpful habits include:
- Avoid sitting for several hours without standing.
- Change positions regularly.
- Walk throughout the day.
- Warm up before exercise.
- Increase activity gradually.
- Lift using your hips and legs rather than your back alone.
- Maintain regular strengthening exercises.
- Stay physically active.
These strategies support overall movement health but should not replace professional assessment when pain persists.
When Should You Seek Physiotherapy?
Consider booking an assessment if:
- Back pain lasts longer than two weeks.
- Pain repeatedly returns.
- Walking becomes uncomfortable.
- Sitting aggravates symptoms every day.
- You notice reduced hip mobility.
- Pain interferes with work or exercise.
- Daily activities become difficult.
- You are unsure whether your symptoms are coming from your back or your hips.
Early assessment often helps identify contributing factors before long-term movement compensation develops.
When Back Pain Requires Immediate Medical Attention
Most episodes of back pain improve without emergency treatment.
However, seek immediate medical care if you experience:
- Loss of bladder or bowel control
- Numbness around the groin or saddle area
- Significant leg weakness
- Severe pain following a major fall or accident
- Fever with severe back pain
- Unexplained weight loss
- Progressive numbness affecting the legs
These symptoms require prompt medical evaluation. (mayoclinic.org)
Frequently Asked Questions
Can hip arthritis feel like back pain?
Yes. Hip osteoarthritis may cause pain in the groin, buttock, thigh, or lower back because movement patterns change as the hip becomes stiffer.
How do I know if my pain is coming from my hip or spine?
A physiotherapy assessment evaluates both areas to determine which structures reproduce your symptoms and whether both regions are contributing.
Can weak glute muscles cause back pain?
Yes. Weak hip muscles may reduce pelvic stability, causing the lower back to work harder during walking, lifting, and standing.
Is walking good for hip-related back pain?
Walking is often beneficial, but the appropriate amount depends on your condition. Your physiotherapist can help determine the right activity level for your symptoms.
Can sitting all day tighten my hips?
Yes. Prolonged sitting may temporarily reduce hip mobility and tighten the hip flexor muscles, which can influence lower-back movement.
Will stretching my hips fix my back pain?
Stretching may improve flexibility, but lasting improvement often requires strengthening, movement retraining, and addressing the underlying cause of the problem.
Can physiotherapy prevent my back pain from returning?
Physiotherapy may help reduce the likelihood of recurring pain by improving strength, mobility, posture, movement quality, and activity management.
Do I need imaging before physiotherapy?
Not necessarily. Many cases can be assessed clinically without imaging unless there has been significant trauma, severe neurological symptoms, or another medical concern.
Find the Real Source of Your Pain
Lower back pain is not always caused by a problem in the spine. In many cases, restricted hip mobility, muscle weakness, altered walking mechanics, or hip joint dysfunction may be placing extra stress on your lower back.
Treating only the painful area without identifying the true source may lead to recurring symptoms.
At CN Physiotherapy, our experienced physiotherapists perform comprehensive assessments of the spine, hips, strength, mobility, posture, and movement patterns to identify what is contributing to your pain. We then develop an individualized treatment plan designed to help you move more comfortably, regain confidence, and return to the activities you enjoy.
If you’ve been struggling with ongoing lower back pain, contact CN Physiotherapy today to schedule a physiotherapy assessment and discover whether your hips may be part of the solution.
